Some of the signs and symptoms of perimenopause are mainly abnormal bleeding, which needs to be evaluated because it could also be a sign of something different and something concerning, such as a uterine malignancy. Certainly it would be evaluated, but the most common sign and symptom of perimenopause is abnormal bleeding.
Other signs and symptoms could be the same as with hot flashes. There can be intermittent hot flashes that can occur, like one would have in menopause, in perimenopause. Generally, the levels of estrogen are higher in perimenopause than obviously in menopause. The biggest concerning symptom is abnormal bleeding.